Open-Label Placebos and Test Anxiety

Ayesha Azeem ‘23

Figure 1. Test anxiety is a problem for many students around the world with 13% of German undergraduate students receiving counseling services for test anxiety.

Test anxiety is a condition that affects up to 40% of students who suffer immense stress and worry before and while taking a test. Anxiety in test situations can present itself in many different ways and may not seem so apparent to the sufferer at first. Symptoms include: nervousness, high heart rate, sweating, avoidance, and failing concerns. Anxiety can weaken the ability to perform challenging tasks requiring critical thinking and reduces students’ motivation when they feel overwhelmed. Though standard treatment of test anxiety includes medication and therapy, studies have shown that even placebos can reduce anxiety for students. However, administering placebos is unethical since concealing the fact that the pill is a placebo is necessary and causes conflict with informed consent and trust. In a recent study conducted in Berlin Medical School in Germany, Michael Schaefer and team examined and administered open-label placebos (placebos without concealment) to subjects and tested whether OLPs can improve test anxiety and self-management skills.

To administer the study, the team conducted a randomized controlled trial that included 58 student participants, 50 females and 9 males, two weeks before they took a university exam. The participants provided written informed consent. The student participants were recruited using flyers at a local university and through social media and were between the ages of 18 to 60 years, with the mean age being 22.9 years. Participants were randomly assigned to their respective experimental group; in the open-label placebo group, subjects received placebos without deception, and the control group received no pills. Both groups received similar participant-provider interaction and contact time. All participants were briefed in the same way and participated in questionnaires assigned to evaluate their test anxiety, quality of life and self-management abilities. The placebo group members received a white tube that was labeled with the university’s logo and said: “Placebo pills (28)” and instructed the subjects to swallow the pill twice a day for two weeks. After two weeks, participants visited the researchers, who once again assessed test anxiety, quality of life, and self-management abilities.

Though the baseline scores of the questionnaire before starting the experiment were not very different from each other, the second questionnaire displayed a significant reduction in test anxiety within the open-label group, while the control group showed a non-significant reduction. For the open-label placebo group, self-management abilities increased with lower test anxiety levels, but the quality of life measurement did not witness a significant change with lowered test anxiety. The improvement in self-management skills in the open-label group had a positive relationship with exam results, suggesting that an open-label placebo treatment may reduce test-anxiety and improve exam scores for students.

Other factors for the improved test anxiety include a positive patient-provider relationship, which may cause the patient to feel supported and safe and thus improve health status. There were several limitations of this study such as short sample size and the absence of a concealed placebo condition. Additionally, the duration of the trial was short (two weeks) and the long-term effects of an open-label placebo remain unknown. Participants were also told about the power of placebos on the mind and body before the baseline assessment which may have skewed the questionnaire’s results. Though these limitations should be noted, the results of this study do emphasize a hopeful future for students. With further research, test anxiety may be eventually conquered.